Nuclear Medicine: Determining Its History
There are nuclear weapons, nuclear energy and even the nuclear family, but today, one of the most exciting and timely “nuclears” is nuclear medicine. This allied health specialty is on the verge of an unprecedented chapter in its long and prestigious history. The field is set to take on amazing changes in technology and awesome career opportunities, all at a record pace.
In the Beginning
In the 100-plus years since Henri Becquerel discovered the mysterious “aura” generated by uranium, the science of nuclear medicine has traveled a long road filled with revolutionary accomplishments. First, Madam Marie Curie labeled that aura as “radioactivity” in 1897. Within four years, Alexander Graham Bell had come to believe that placing sources of radium on or near tumors could be a significant health breakthrough. Although that practice may not have been the safest or most effective means of caring for patients, experts of the day were convinced the science had a viable medical purpose. Additional research led to the first published study in 1913, explaining the use of intravenous radium injections as a therapy for various diseases. From then on, the field only gained momentum.
Throughout the 20th century, numerous advances furthered the number and scope of applications. The 21st century sees nuclear medicine as one of the most technical and innovative health care specialties. Today, nearly every discipline benefits from its diverse capabilities. Oncologists use it to view tumors and surrounding tissues. There are also radioactive therapies that target cancerous cells. Cardiologists rely on nuclear medicine to provide accurate scans of damaged areas within the heart. Pediatrics, orthopedics and even pain management all use scans in order to determine treatment plans.
Perhaps the most influential development in recent times, however, is the positron emission tomography (PET), which provides 3-D computer-reconstructed images that measure metabolism and the degree of function in an organ or tumor. This enables doctors to assess neurological disorders, cardiovascular disease and a variety of cancers, including lung, breast, thyroid, esophageal, cervical, pancreatic and lymphoma.
Nuclear medicine is so diverse, in fact, that the Society of Nuclear Medicine (SNM), the specialty’s professional association based in Reston, Va., reports nearly 100 different imaging and therapeutic procedures are available. That variety makes nuclear medicine a very reliable diagnostic tool—no wonder it’s a routine component in countless treatment plans. SNM estimates nuclear medicine technologists (NMTs) perform between 10 to 12 million procedures per year. That statistic is primed to soar as the specialty undergoes yet another transformation as companies continue to push technical boundaries.
Keeping Up With the Times
As one might expect, the computer has greatly changed the practice of nuclear medicine. Gone are the days when a single camera occupied an entire room. Thanks to microchip technology, physicians and technologists now operate compact, digital cameras that provide clearer, more succinct and targeted scans.
“The more sophisticated computers become, the faster techs are able to do things. Some of the things we did 10 or 12 years ago we don’t even do now because we can do other procedures better with newer technology,” says Erasmo Carrasco, CNMT, ARRT (N), a technologist who travels for Teamstaff Rx.
“Nuclear medicine definitely has become more technical,” adds Neeta Pandhit-Taskar, MD, a clinical assistant physician at Memorial Sloan-Kettering Cancer Center in New York, as well as an assistant professor of nuclear medicine services and radiology at Cornell University. “Over the last few years there have been a lot of developments, especially in PET. It’s a growing area.”
Additionally, the equipment used in nuclear medicine continues to advance the expertise of its operators. Technologists in this area experience a wide breadth of procedures and equipment, and as a result, they are often perfect candidates for numerous career choices. As a traveler, Carrasco is constantly supplied with invaluable opportunities. “Assignments allow you to learn new equipment and procedures; it’s a meaningful experience,” he explains. “Also, there are a lot of good techs out there to learn from, and they know what they’re doing.”
Increased reliance on nuclear medicine in conjunction with ongoing technical evolution has resulted in one of the healthiest employment environments in the health care industry. The U.S. Bureau of Labor Statistics (BLS) reported approximately 18,000 nuclear medicine jobs were held in 2000. The BLS also labeled the specialty as one that’s “expected to grow faster than average…through the year 2010.” That’s good news for the current 14,000 certified technologists nationwide, but even better news for those just entering the profession. Simply put, the demand for qualified NMTs will continue to grow unabated for the foreseeable future.
“I have seen it go from a glut of technologists [with not enough jobs], to now when there is more need and fewer techs,” comments Brenda King, a clinical specialist for Bristol-Myers Squibb (BMS) in its medical imaging division in Los Angeles.
Like so many health care disciplines, nuclear medicine has endured cyclical employment periods in the past. What makes this upswing different? Some of the same factors contributing to the current nursing shortage, which is one of the worst in history, are affecting nuclear medicine: Namely, an aging public and work force.
As the population ages, the demand on health care increases, which very likely could result in busier nuclear medicine departments. Even now, large acute care hospitals have expanded their nuclear medicine facilities to fulfill current requests. “There is the potential to have many cameras in one department, as well as to have cameras in different departments under the same license,” notes Lynn Fulk, CNMT, ARRT (R), program director of the nuclear medicine technology program at Ball State University in Muncie, Ind.
But as the number of orders swells, the staff will need to grow proportionately. Unfortunately, the current work force, from techs to doctors and even radiologic pharmacists, is aging. As these individuals retire, their positions must be filled in order to continue meeting hospitals’ needs. Industry experts, however, say nuclear medicine education programs certificate as well as associate and bachelor’s degrees aren’t producing enough graduates. In the long-term, this scenario will result in serious staffing shortages.
Unlike the nursing crisis, however, this allied health specialty’s situation differs because the number of environments employing NMTs has grown dramatically in recent years. The new competition for techs comes from private imaging centers. These businesses have a firm hold in the marketplace, appealing to consumers’ increasing desire for full-body scans that promise to help with early disease detection or to put worried minds at ease.
Another contender is private medical practices. Orthopedists, cardiologists and other physician specialties have invested in in-house nuclear medicine equipment in order to provide further assistance to their patients, as well as another means to generate income.
“There are radiology groups that have acquired PET and computerized tomography (CT) equipment,” notes Pandhit-Taskar.
“Doctors’ offices, imaging centers and hospitals are all competing for technologists. There are a lot of techs quitting hospitals to work in offices or centers where there aren’t on-call requirements,” explains Carrasco. “[As traveling technologists], we’re usually filling in for someone who left to work somewhere else.”
In his six years of traveling, Carrasco says he has rarely been without a job. “The places [travelers] go to work are hurting for techs, and the current staff is usually already overworked.”
Manufacturers are also vying for NMTs to aid in their research and development efforts, as well as to work in sales. After all, who knows the equipment better and can earnestly convey its benefits to potential customers? King, for example, wanted a new challenge after nearly 20 years in the hospital environment. It was her clinical skills that trained her for a sales position at BMS. “I saw it as an area for growth and a chance to show what a NMT could do,” she says. “I could have stayed and scanned patients or dealt with radiologic pharmacists for the rest of my career, but I felt there was something more out there and a sales job could be a stepping stone.
“There are [corporate] opportunities for [an NMT] who is prepared for them,” she continues. Now King applies her clinical experience with her customer service skills to research and development efforts, including clinical trials. “I have different customers now and they rely more on my technical expertise.”
Preparation Is Key
Although techs may be leaving the clinical environment, they remain within the specialty. For many people, it’s the variety that keeps them there. From traditional scans to antibody therapy research or even equipment sales, nuclear medicine continues to evolve, prompting constant progression of skills. Indeed, the critical exactness required for most procedures insists techs maintain a high level of expertise. “You always have to think, especially when dealing with radiation,” says Carrasco. “There is always new equipment and procedures to learn, which keeps the job from becoming routine.”
“It’s not just anatomical scans,” adds Pandhit-Taskar. “There is basic science involved as well as sophisticated technology used to assess different physiological processes. That’s one of the strong appeals of nuclear medicine, there is so much to do in the field.”
Unlike so many other disciplines, not all states require NMTs to be licensed. Still, most mandate some proof of competence, usually certification by either the Nuclear Medicine Technology Certification Board (NMTCB) or the American Registry of Radiologic Technologists (ARRT). Both organizations require candidates to complete an education program and a minimum of clinical practice hours. Continuing education hours are also mandated in order to renew licensure or maintain certification.
The buzz in the industry, however, is a call to eventually raise the minimum qualifications to a bachelor’s degree, as well as to establish an advanced level of practice. “Advanced practice technologists, like nurse practitioners (NP) or physician assistants (PA), will become more [commonplace]. The general NMT will need to have more specific advanced skills and knowledge,” suggests King.
“If they do not have a bachelor’s degree, I recommend students stay in school in order to get it,” adds Fulk. “Employers want students to be qualified to do more than just the basic entry-level medicine. They want students to be exposed to CT and radiology physics.”
Always Something Different
Another pro to a career in nuclear medicine, say seasoned professionals, is the diversity inherent to the specialty. Because it applies to many areas within health care, techs routinely interact with a broad spectrum of hospital personnel from nurses to PAs, physicians, pharmacists and, of course, other NMTs. Often, the tech sits in on treatment plan meetings and offers his or her expertise.
“Plus we have subgroups of disease management teams that meet and discuss interesting cases. It really is a multimodality interaction,” states Pandhit-Taskar.
Additionally, techs interact with the facility’s client community. Not only do they perform the scans and therapies, but NMTs also spend time with patients. From obtaining medical histories to explaining procedures, techs play a role in coaching people through their treatments. “It’s what makes nuclear medicine very interesting; we’re not just reading films,” asserts Pandhit-Taskar.
Because of this connection with staff and patients, experts agree diversity within the discipline is critical. “To have someone who understands your culture and language goes a long way in being able to deliver health care,” asserts King, who is African American.
There have been notable changes in the specialty’s demographics during the past 20 years. Still, Caucasian females hold the majority of positions. Geography, however, can make a difference. In his experience, Carrasco, a Mexican American, says certain urban and regional areas boast more ethnic diversity. “It really depends on where you are,” he states. “In the Southwest, you see more people of my nationality working in nuclear medicine, but in Maine, there aren’t a lot of Hispanics.”
“It’s a slow process to get more diversity in the health care field…but we’re trying to raise NMT as a career opportunity for upcoming students,” says King.
The Society of Nuclear Medicine is not only striving to stir up the ethnic mix in nuclear medicine, but it’s also campaigning to spread the word about the specialty. The predicted shortage could have a huge impact on the health care industry unless more people are informed about the infinite possibilities available with a nuclear medicine career. “There are new opportunities opening up all the time,” Fulk emphasizes.
Indeed, depending on what unfolds within the next few years, this exciting field could be penning its most impressive chapter yet.